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A Rush to Get Treatment: When Alzheimer's Drugs Arrive, How Prepared Will We Be to Meet Demand?

An Assessment of U.S. Health Care Infrastructure

Early intervention is the key.

Because no drug has thus far been shown to reverse established Alzheimer's dementia, halting progression in early stages of the disease is the most likely pathway for treatment. There is hope that one or more drug therapies, including infused drugs, may become available by 2020. At that point, a complex patient journey will start —sending those over the age of 55 on a four-part path, involving various specialists with multiple appointments at different facilities, to:

Screen for mild cognitive impairment (MCI).

Evaluate for potential Alzheimer's disease.

Test for signs of brain pathology.

Treat with intravenous (IV) infusion therapy.

Ideally, this process would happen as quickly as possible to prevent progression, but is the U.S. health care system ready? Projections based on a simulation model developed by RAND researchers suggest otherwise.

An Anticipated Rush to Treatment Facilities

A deluge of patients will arrive at the doors of limited-capacity centers — first screening and dementia specialist offices, then testing facilities, and, finally, treatment centers.

Millions of patients would need to be seen.

Of the 88.4 million people 55 years and older who are eligible 70.7 million would get screened in a doctor's office

Of the 14.9 million who screen positive for MCI 7.5 million would see a dementia specialist for evaluation

6.7 million would get amyloid biomarker testing

3.0 million might test positive for amyloid deposits and return to the specialist to learn about treatment

2.4 million 14 IV treatments in one year would receive treatment at infusion centers

Wait times might be extensive.

1-year wait

8-month wait

4-month wait

no wait

2019

2024

2028

2033

Dementia Specialist Visit

Patients could face more than a 14-month wait for their first appointment with a specialist

Amyloid Testing

At the peak of demand, waits for amyloid testing could exceed 11 months

Infusion Treatment

By 2020, 33 million infusions might be needed

It could take more than a dozen years to clear the backlog of cases

Delays in access to care could result in people getting sicker.

Failure to increase capacity means that as many as 2.1 million patients might develop Alzheimer's dementia while waiting for evaluation and treatment between 2020 and 2040

But with increased capacity, millions could be helped.

With enough capacity for testing and treatment an additional 800,000 people would not develop Alzheimer's dementia

And with enough capacity for all aspects of care (diagnosis, testing, and treatment) an additional 2.1 million people might not develop Alzheimer's dementia

Action is needed to reduce capacity constraints.

Train more providers in dementia care and develop tools to make them more efficient.

Expand the range of diagnostic options.

Utilize all options for infusion therapy, including the home setting.

Ensure appropriate coverage of services and tests.

Excerpted from Assessing the Preparedness of the U.S. Health Care System Infrastructure for an Alzheimer's Treatment, by Jodi L. Liu, Jakub P. Hlavka, Richard Hillestad, and Soeren Mattke, RAND Corporation, RR-2272-BIOG, 2017 (available at www.rand.org/t/RR2272.

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The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.